diabetic foot. dr.ajit kumar varma

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THE DIABETIC FOOT: A SURGICAL PERSPECTIVE. Dr.Ajit Kumar Varma, Dr.Ajit Kumar Varma, M.S. M.S. Senior Consultant, Senior Consultant, Diabetic lower limb and Diabetic lower limb and Foot & ankle reconstructive surgeon. Foot & ankle reconstructive surgeon.

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Page 1: DIABETIC FOOT.   Dr.Ajit Kumar Varma

THE DIABETIC FOOT: A SURGICAL PERSPECTIVE.

Dr.Ajit Kumar Varma,Dr.Ajit Kumar Varma, M.S.M.S. Senior Consultant,Senior Consultant, Diabetic lower limb and Diabetic lower limb and

Foot & ankle reconstructive surgeon.Foot & ankle reconstructive surgeon.     

Page 2: DIABETIC FOOT.   Dr.Ajit Kumar Varma

WHY MAJOR LOWER LIMB WHY MAJOR LOWER LIMB AMPUTATION SHOULD BE AMPUTATION SHOULD BE PREVENTED IN A DIABETIC PREVENTED IN A DIABETIC

PATIENT.PATIENT.

Every 30 seconds a leg is still lost because of diabetes, somewhere in the world.

Page 3: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Let us review some of the Let us review some of the incorrectincorrect practices in India, leading to foot practices in India, leading to foot injuries.injuries.

Page 4: DIABETIC FOOT.   Dr.Ajit Kumar Varma

BARE-FOOT WALKING

Never walk barefoot. It can cause foot problems.Always use prescription Diabetic foot wear.

Page 5: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Rat-bite Injury&

Ant bite injuries

Page 6: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Injury caused by massage –Necrotizing

Fasciitis.

Page 7: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Thermal Injury

Page 8: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Self Surgery,A DangerousPractice.

Page 9: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Interdigital Fungal infections—Immidiate Treatment Required.

Page 10: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Trans metatarsal and Transtarsal foot amputations.Trans metatarsal and Transtarsal foot amputations.

Page 11: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Extensive Necrotizing Fasciitis of the leg:---Most of these patients are very sick, some requiring ICU care

Page 12: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Granulating woundsGranulating wounds

Page 13: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Split Skin GraftingSplit Skin Grafting

Page 14: DIABETIC FOOT.   Dr.Ajit Kumar Varma

““OFFLOADINGOFFLOADING” ” the diabetic foot for any foot or the diabetic foot for any foot or lower limb problems is VITAL in lower limb problems is VITAL in the management. the management.

““More than what you put on the More than what you put on the wound, it is what you take wound, it is what you take “ “ OFF OFF ”” from it, that is from it, that is important. ”important. ”

Page 15: DIABETIC FOOT.   Dr.Ajit Kumar Varma

10 commandments of the diabetic foot care:

1. I am thy foot forever. Take good care of me, for thou shalt have no foot other than me.

2. Thou shalt regularly debride me, when I develop callosities and ulcers.

3. Thou shalt fit me with casts and insoles to offload my high pressure areas.

4. Thou shalt carefully look for early signs of infection in me and treat it aggressively.

Page 16: DIABETIC FOOT.   Dr.Ajit Kumar Varma

5.Thou shalt diagnose ischaemia without delay and revasularise me.

6.Thou shalt educate all patients how to examine me and take care of me.

7.Thou shalt carefully inspect the shoes that I have to wear and encourage the use of appropriate footwear.

8.Thou shalt continuously aim to achieve tighter blood glucose control for me.

9.Thou shalt not commit amputation on me, unless there is a compelling reason.

10.Thou shalt try to improve upon your lower limb salvage methods.

Page 17: DIABETIC FOOT.   Dr.Ajit Kumar Varma

Important Investigations:1.Ankle Brachial Index for macrocirculation.2.Vibration Perseption Testing for Neurapathy.3.tcpo2(microcirculation).4.Pedopodogram for plantar pressure measurements.

Important Treatment modalities:

1.Negative Pressure Wound Therapy2.Anodyne therapy for neuropathy.3.Hyperbaric Oxygen Therapy.4.Stem Cell Therapy.

Page 18: DIABETIC FOOT.   Dr.Ajit Kumar Varma

REVASCULARISATION PROCEDURES

ANGIOPLASTY PERIPHERAL BYPASS

Page 19: DIABETIC FOOT.   Dr.Ajit Kumar Varma

AMPUTATION PREVENTION is our AMPUTATION PREVENTION is our motto.motto.

COMPREHENSIVE TEAM COMPREHENSIVE TEAM APPROACH HAS HELPED US TO APPROACH HAS HELPED US TO

ACHIEVE EXCELLENT FOOT ACHIEVE EXCELLENT FOOT SALVAGE RATE EQUAVALANT TO SALVAGE RATE EQUAVALANT TO

THE BEST CENTERS IN THE THE BEST CENTERS IN THE WORLD. WORLD.

Page 20: DIABETIC FOOT.   Dr.Ajit Kumar Varma

CONTACT DETAILS:CONTACT DETAILS:

House Address : Dr.Ajit Kumar Varma                AMRITAKRIPA,                49/524-H,                KALPAKA VILLAS,                PARAYIL ROAD,                PUTHUKKALAVATTOM,                PUNNAKKAL,                ELAMAKKARA P.O,                KOCHI  682 026.                KERALA. INDIA. E Mail [email protected]

Official Address: Dr.Ajit Kumar Varma Senior Consultant. Department of Podiatric Surgery. Aster Medcity Hospital, Kuttisahib Rd, South Chittoor, Kochi--682027. Kerala, India. Email: [email protected] Phone: 91 484 6699999